Kidney Disease in Pregnancy

During pregnancy, more blood flows to the kidneys as they work harder to filter waste products faster to take care of the needs of both the woman and her fetus. If a woman’s kidneys are weakened from a previous disease or do not work properly, it could have an effect on her pregnancy. With proper medical treatment, however, risks usually can be reduced. Some disorders that affect the kidney are linked with high blood pressure. If the blood pressure can be controlled, the risk of problems during pregnancy is reduced.

Kidney disease can usually  be diagnosed on the basis of your medical history, physical exam, and blood and urine tests. Protein in the urine may be a sign of kidney disease. It can be caused by diseases that interfere with kidney function. Urinary tract infections and high blood pressure in a pressure in a previous pregnancy also are signs that require further evaluation.

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The Bad Effects of Rubella (German Measles) During Pregnancy

There are different type of measles caused by various viruses. Most do not cause problems during pregnancy. The type that has the most severe effects during pregnancy is caused by rubella virus and is known as German measles. Since 1969, when a vaccine for rubella became available, preschool and young  school-age children have been vaccinated. It has been estimated that about 75-80% of the population is protected against rubella by the time they reach childbearing age because they have been exposed to the disease, have had it, or have been vaccinated. Once infected with rubella virus, you are immune for life, even if the infection doesn’t actually make you ill.

It is fortunate that so few people are now susceptible to rubella, because the virus can cause birth defects and long-term disorders in babies who are exposed to the virus while their mothers were pregnant. The risk depends on when infection occurred during the first month, about 50% of the babies will be affected. By the third month, the risk is lowered to about 10%. The most common problems include cataracts (an eye problem that can cause blindness), heart defects, and deafness-together called congenital rubella syndrome. Other disorders, such as diabetes, can develop later in life.

As a routine part of prenatal care, each pregnant woman is tested for antibodies to show whether she is immune to rubella. If there are sings that a women is not immune but may have been exposed to rubella or if she develops symptoms (fever, rash swollen lymph glands), she will be tested again. If the diagnosis of rubella infection during pregnancy is confirmed, a type of immunoglobulin may be given. If the women has been exposed to rubella but has not developed the disease, the immunoglobulin may prevent her from becoming ill. It will not prevent the fetus from being affected, however.

Because rubella can give such a severe impact on the fetus and because nothing can be done during pregnancy to protect the fetus, it is best that a women receive the rubella vaccine before she becomes pregnant. A woman who has not had rubella or the vaccine could be vaccinated just after delivery, before she becomes pregnant again. Although the vaccine does not cause congenital rubella syndrome, the virus in the vaccine may be able to infect the fetus. Therefore, it is best to wait 3 month after receiving the vaccine during early pregnancy, however, the risk that the baby will have a problem is very low.

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Strategies of Pain Relief in Childbirth

Many women take childbirth preparation classes to learn what to expect during labor and delivery. They also learn breathing methods, relaxation techniques, and other ways of coping with pain and discomfort during childbirth. These classes can be quite valuable, and some women are able to use these techniques to get through childbirth without needing pain medication. Other women find that using these techniques combined with some medications relieves the discomfort of labor and birth. Throughout delivery, your nurse will be available to reassure you and help make you more comfortable.

Your wishes will be taken into account in deciding what type of pain relief is best for you. Many other factors, including your well being and that of your baby, will affect this choice. Often your doctor will not be able to tell you exactly what kind of pain relief you will receive until you are in labor or are ready to deliver. Many times these choices must be left open and flexible until your doctor sees how your labor is going. Also, you may not always be able to have medication just when you feel you need it.

Pain-relieving medications fall into two general categories. Analgesia is the relief of pain without total loss of sensation. A person receiving and analgesic medication remains conscious. Al though analgesics don’t always completely stop pain, they do lessen it. Anesthesia refers to the total loss of sensation. Some forms of anesthesia cause a loss of consciousness, whereas others remove the sensation of pain from specific areas of the body while the patient remains conscious.

The decision to use a pain medication and what type to use will depend on several factors. Not all types of pain medications are available at all institutions, and not all doctors are able to give every type. Often the choice cannot be made until labor is under way. Your doctor may work with and anesthesiologist-a doctor who specializes in pain relief-in selecting the best method for you, depending on how your labor or delivery is going and the state of your health. And, of course, the effect of the medication on your baby must also be considered.

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Urinary Tract Infection During Pregnancy

Urinary tract infections are common in pregnancy. Severe infections can cause problems for both mother and fetus. Some urinary tract infection can be detected only by tests-there may be no symptoms to let you know that you have an infection. Your doctor will be testing you regularly, however, to avoid any problems. Some symtoms linked with urinary tract infection, such as painful urination, can be caused by other problems, such as infection of the vagina or vulva. To help your doctor make the correct diagnosis, you shold bring any changes to his or her attention.

Cysitis is a lower-tract (bladder) infection. Its symtomps include an increased need to urinate, buring and pain during urination with possivble signs of blood in the urine, and discomfort in the lower abdomen. With proper treatment, this condiation usually clears up right away.

Pyelonephritis is an upper-tract (kidney) infection. Its symptoms are similar to those of cystitis. However, pyelonephritis can also cause chills, fever, rapid heart rate, and nausea or vomiting. This condition can cause premature labor or septic shock. If you have pyelonephrits, you will probably be hospitalized for treatment and careful monitoring. Under these conditions, most patients recover within 48 hours.

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Special Care for High Blood Pressure & Pregnancy

Pregnancy puts new demands on a woman’s body. It can alter the course of some medical conditions a woman may have before pregnancy, and some conditions can affect the course of pregnancy. A woman with such a medical condition can have a healthy baby. An extra effort will be required, however, so that the woman’s general health and her pregnancy can be followed more closely.

If you have a condition that could complicate your pregnancy, your doctor may order additional tests and ask you to make extra prenatal visits or attend special clinics. You may need to stay in the hospital or to monitor your condition yourself at home. Your doctor may work with a team of experts to provide any special care you may need.

High Blood Pressure

Hypertension, or high blood pressure, occurs when the pressure of the blood in the arteries reaches levels that are greater than normal. This condition can be preexisting (before pregnancy) and chronic (long-term), or it can arise during pregnancy. High blood pressure that arises during pregnancy can be a sign of a condition called preeclampsia (also known as toxemia). These two conditions – chronic high blood pressure and preeclampsia affect pregnancy and its outcome in different ways. Depending on how severe these conditions are, both the mother and fetus can be affected.

The heart pumps blood rich in oxygen through the arteries (light blood vessels) to all parts of the body. Blood returns to the heart through the veins (dark blood vessels).If a blood pressure reading is 110/80, 110 is the pressure in the arteries when the heart is contracting, or the systolic pressure. The lower number, 80, is the pressure in the arteries when the heart is relaxed, or the diastolic pressure.

Measuring Blood Pressure

Blood pressure is checked with a stethoscope and an instrument made of an inflatable cuff and a pressure gauge (sphygmomanometer). A blood pressure reading is made up of two numbers separated by a slash, for example, 110/80. (You may hear this referred to as”110 over 80”). The first number is the pressure in the arteries when the heart contracts. This is called the systolic pressure. The second number is the pressure in the arteries when the heart is relaxed between contractions. This is the diastolic pressure.

Blood pressure changes often during the day. It can rise if you are excited or if you exercise. It usually falls when you are resting. These temporary changes in blood pressure that occur in response to some activity or event are normal. It is only when a person’s blood pressure stays high for some time that it requires attention.

Because of the normal ups and downs in blood pressure, if your doctor finds one high reading, he or she will want to see whether it is your normal level by taking another reading. Your normal blood pressure can be an average of several readings taken at rest.

Blood pressure varies from person to person, so everyone’s blood pressure is different. In nonpregnant adults, readings less that 130/80 are usually normal, and become abnormal when pressures reach above 140/90.

Some blood pressure levels that may see normal could be too high in a pregnant woman. For instance, a reading of 120/85 would be considered too high for a pregnant woman whose normal reading was 90/70. As a rule, any increase of 30 or more in the systolic reading or 15 or more in the diastolic reading can be a sign of high blood pressure in pregnancy.

It is normal for blood pressure to drop slightly during the middle part of pregnancy and then return to pregnancy levels during the latter part of pregnancy. Because of these changes, it is important to have your blood pressure measured before pregnancy or in early pregnancy so your doctor will know what is normal for you. As a part of prenatal care, a woman’s blood pressure is checked at each visit.

Chronic High Blood Pressure

High blood pressure can be present when a woman becomes pregnant. Diet, life style, and heredity con tribute to chronic high blood pressure. Over the course of her life, a woman with untreated high blood pressure is more likely to have a heart attack or stroke. She is also at higher risk for having problems during pregnancy. These include having a baby that is too small or separation of the placenta from the wall of the uterus before the fetus is born.

Before you get pregnant chronic hypertension should be brought under control with diet, weight loss, and possibly medication. During pregnancy, regular checkups are important to detect any changes in your condition that may signal a problem.

What is Preeclampsia?

High blood pressure that occurs for the first time in the second half of pregnancy along with protein in the urine and, usually, fluid retention is called preeclampsia. It affects about 7 out of every 100 women who become pregnant. It is not known what causes preeclampsia, although women who have chronic high blood pressure are more likely to develop it. Most women with preeclampsia, however, have never had high blood pressure before. Preeclampsia usually occurs with first pregnancies and often does not recur in later pregnancies except in women who have chronic hypertension or other diseases affecting the blood vessels. With preeclampsia, blood pressure returns to normal levels after pregnancy, whereas chronic hypertension remains after delivery.

The blood vessels in the uterus supply blood to the placenta, through which the fetus is nourished and given oxygen. When a woman has preeclampsia, the blood flow through these vessels is reduced. The severity of the condition and the time in pregnancy when it occurs determines the degree of risk to the fetus.

When blood pressure increases during pregnancy, your doctor may recommend bed rest. Frequently, the blood pressure will improve or return to normal with rest. When resting the woman may be advised to lie on her side-this position improves the flow of blood to the uterus and kidneys. Some doctors hospitalize women as soon as there is a slight increase in blood pressure; others wait until there is evidence that bed rest at home has not helped to reduce blood pressure.

Caption:Bed rest may be prescribed for a woman with preeclampsia.

Preeclampsia occurs in degrees, from mild to severe, and can gradually worsen or improve. If preeclampsia is detected in mild stages and controlled by bed rest and medication, the effects on the baby can be reduced. The goal, all other factors permitting, is to allow the pregnancy to continue until the fetus is old enough to be born.

When preeclampsia occurs early and is severe, early delivery may be necessary. A premature body is underweight and may have trouble breathing because the lungs are not fully developed. When preeclampsia is associated with chronic hypertension, the placenta can separate from the uterus and result in stillbirth. Preeclampsia can also be linked to poor fetal growth. Severe preeclampsia can also be linked to poor fetal growth. Severe preeclampsia affects almost all of the mother’s organs, such as the blood system, liver, kidneys, and brain. Convulsions can occur without warning with preeclampsia. When this occurs, the disease is called eclampsia. The treatment for very severe preeclampsia or eclampsia is to deliver the fetus, either by inducing labor or performing a cesarean birth.

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Planning for Pregnancy

Pregnancy is a major event. When it is planned in advance, a woman can make decisions that will benefit both her health and that of her baby. Good general health before pregnancy can help you cope with the stress of pregnancy, labor, and delivery. It can also help ensure that neither you nor your baby is exposed to things that could be harmful.

Many women do not know they are pregnant until 5, 6, or even 8 weeks. About 2 weeks after a woman’s menstrual cycle, an egg can be fertilized by a man’s sperm; it then moves to a woman’s uterus and becomes attached there to grow. These early weeks are some of the most significant ones for the baby, because it is during this time that the baby’s body and internal organs are formed. Certain substances for example, alcohol, cigarettes, and drugs-may interfere with that growth, whereas a healthy life style may help promote it. Preconception, or pre pregnancy, care can guide you in planning for a healthy pregnancy.

Preconception care:

Becoming a parent is a major commitment filled with challenges, rewards, and choices. By making some plans and adjustments now, you will promote a healthy pregnancy later. Some aspects of pregnancy are part of the natural process over which you have no control. However you can control one of the most important factors in determining your health and that of your baby-your life style. Planning for pregnancy in advance can help prepare you for the experience ahead and help promote a healthy life style for your future.

A Preconception Visit: Pregnancy-planning

You may wish to arrange a special visit with your doctor to discuss your plans for pregnancy. As part of your preconception visit, you will be asked questions about your medical history, any past pregnancies, and your life style. The answers to (preconception care inventory such as family history, Genetic history, Medical history, Current medication, Nutrition, Environmental factors, Obstetric history, Counseling) these questions should be honest and open. This information may be discussed during a preconception visit. They will let your doctor know whether you may need special care duringpregnancy, and they will be treated as confidential information.

Some women have medical conditions that require special attention or care during pregnancy. The condition may be an illness that was present before pregnancy or it may arise during pregnancy.

Because pregnancy puts special demands on a woman’s body, a health problem that is normally under control can change while you are pregnant. Certain medical conditions, such as hypertension and diabetes, should be brought under control before you become pregnant and may require more frequent visits to your doctor or other special attention. Changes in your life style may also be in order, and your doctor may be able to offer suggestions for improving it.

If you’ve had a problem in a previous pregnancy, that doesn’t necessarily mean that the problem will recur or that you shouldn’t try again. Some problems develop a pattern of repeating, but most do not. If a problem is apt to be repeated you should be aware in advance that you may need special attention before and during your pregnancy.

If you have a family history of birth defects, your doctor may suggest that you see a genetic counselor. Genetic counseling can also help identify a pattern of inherited disorders, if one exists.

Your preconception visit is a time for you to ask questions, too. Don’t hesitate to ask for advice or discuss any concerns you might have. Your doctor is there to provide information and guidelines.

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A Number of Exercise Programs for Pregnant Women

Regular exercise during pregnancy can lead to a better appearance and posture, enhance your feeling of well-being, and lessen some of the discomforts of pregnancy, such as backache and tiredness. The goal of exercise during pregnancy should be to reach or keep a level of fitness that is safe. There is a number of exercise programs designed especially for pregnant women. Your doctor can help you to select exercises that are the best for you.

Here are some prenatal exercises for following a safe and healthy exercise program geared to the special needs of pregnancy:-

Head and Shoulder Circles:

1. Slowly moving your head and shoulders in circles can help relieve upper backache and tension in your head, neck, and shoulders. 

2. Stand or sit in a comfortable position.

3.Inhale while slowly dropping your head toward your left shoulder and circling it to the back and on toward your right shoulder.

4. Exhale while slowly letting your head circles to the front and around to your left shoulder again.

5. Repeat several times.

6. Inhale while slowly moving your right shoulder forward and then upward to form the top half of a circle.

7. Exhale while slowly moving your shoulder to the back and then down to complete the circle.

8. Repeat with your left shoulder.

9. Do three to five repetitions.

Forward Bend

This exercise stretches and relaxes the muscles in your back to help relieve tension and fatigue.

1. Stand with your feet about 12-18 inches apart and your knees slightly bent. As you do this exercise, spread your legs, bend your knees, or do both, as needed for comfort. Don’t try to keep your knees straight.

2. Exhale and bend forward from the waist, letting your upper body slowly sag toward the floor, uncurling slowly.

3. Inhale and slowly uncurl your back, one vertebra at a time, until you are once again standing up straight. (Do not try to keep your back straight or to rise quickly to a standing position, because you may become dizzy.)

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Arm Reaches: 

Stretching your side and upper body helps relieve upper backache. It is also helpful you feel short of breath.

1. First stand or sit in a comfortable position.

2. Inhale as you raise your right arm above your head, reaching as high as you can. (Be sure to stretch from the waist, without letting your arm hip or foot rise.)

3. Exhale, bending your elbow and pulling your arm back down to your side.

4. Repeat on your left side.

5. Do three to five repetitions.

Pelvic Tilt:

Tilting your pelvis back towards your spine can help strengthen your abdominal muscles and relieve backache. This exercise can be done in either a kneeling or standing position.

Standing

1. Stand in a comfortable position.

2. Inhale and relax.

3. Exhale as you roll your hips and buttocks forward, as if trying to lift the fetus up toward your chest.

4. Hold for a count of five.

5.Repeat three to five times, several times a day.

Kneeling

1.  Kneel on your hands and knees, with your back relaxed but not arched.

2.  Inhale and relax a moment.

3.  Exhale and pull your buttocks under and forward (you should feel your abdomen tighten and your back straighten at the waist). 

4. Hold for a count of five.

5. Inhale and relax.

Side Leg Stretches:

This exercise improves your circulation and tones and strengthens the muscles of your hips, buttocks, and thighs.

1.  Lie on your left side, with your knees, hips, and shoulders in a straight line. Put your right hand on the floor in front of you, and use your left hand to support your head.

2. Inhale and relax.

3. Exhale while slowly raising your right leg as high as you can without bending your knee or body. 

4. Keep your foot flexed, with your right outside ankle bone facing up.

5. Inhale while slowly lowering your leg.

6. Repeat 10 times.

7. Turn to your right side and repeat 10 times with your left leg.

Leg Stretches:

Stretches your legs relieve tension in your hips and legs and helps relieve or prevent leg cramps.

1. Sit on the floor with your right leg stretched out toward the side, your foot flexed, and your left leg folded in.

2. Facing forward, lean your upper body to the right side, so that your right ear is directing over your right leg. At the same time, lift your left hand over your head, so that it is directly over your left ear.

3. Using this position for a count of 10.

4. Relax and release the stretch.

5. Repeat on the left side.

6.  Do three times (as you feel more comfortable with this exercise, try to hold the stretch longer).

You can change this exercise two different ways for more variety:

1.      Instead of raising your leg all the way up, raise it only halfway and make small circles with it. Make 10 clockwise circles and then 10 counterclockwise circles.

2.      Instead of keeping your upper leg straight, bend your knee so that your upper thigh is at a right angle to your body. Keeping your knee bent, do the side raises, making sure that your knee faces forward and your outer ankle bone faces upward.

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A Healthy Life Style during Pregnancy

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A Healthy Life Style during Pregnancy

Many of the choices you make in your daily life affect your fetus. This is true of the things you do-exercise, rest, and works-as well as the things you don’t do-expose your fetus to drugs, alcohol, cigarettes, or other risks. Some women may need to change their life style during pregnancy. This change may not be easy, but your doctor and the health care team can give you information and support. Even better is the daily support of your family and friends, and especially your partner. Together, you can construct a healthy life style that will benefit you and your baby.

Exercise during Pregnancy

Regular exercise during pregnancy can lead to a better appearance and posture, enhance your feeling of well-being, and lessen some of the discomforts of pregnancy, such as backache and tiredness. The goal of exercise during pregnancy should be to reach or keep a level of fitness that is safe.

What you can do in sports and exercise during pregnancy depends on your own health and, in part, on how active you were before you become pregnant. This is not a good time to take up a new, strenuous sport, but if you were active before your pregnancy, you should be able to continue, within reason. Caution should be the rule.

Here are some general guidelines for following a safe and healthy exercise program geared to the special needs of pregnancy:  

1.  Regular exercise (at least three times per week) is better than spurts of heavy exercise followed by long periods of no activity.

2.Brisk exercise should not be performed in hot, humid weather of when you have an illness with a fever, such as a cold of flu.

3. Avoid jerky, bouncy, or high-impact motions. Activities that require jumping, jarring motions, or rapid changes in direction may cause pain. Exercise on a wooden floor or a tightly carpeted surface to reduce shock and provide a sure footing. Wear a good fitting supportive bra to help protect your breasts.

4. Avoid deep knee bends, full sit-ups, double leg raises, and straight-leg toe touches. During pregnancy, these exercises may injure the tissue that connect your leg and back joints.

5. Avoid exercises that require lying with your back on the floor for more than a few minutes after 20 weeks of pregnancy.

6. Always begin with a 5-minute period of slow walking or stationary cycling with low resistance to warm up your muscles. Intense exercise should not last longer than 15 minutes.

7. Heavy exercise should be followed by a 5-10-minute period of gradually slower actively that ends with gentle stretching in place. To reduce the risk of injuring the tissue connecting your joints, do not stretch as far as you possibly can.

8. The extra weight you are carrying will make you work harder as you exercise at a slower pace. Measure your heart rate at a peak times of activity. Do not exceed your target heart rate and limits established with your doctor’s advice.

9. Get up slowly and gradually from the floor to avoid dizziness or fainting. Once you are standing, walk in place for a brief period.

10. Drink water often before and after exercise to prevent dehydration. Take a break in your workout to drink more water if needed.

11.  Women who did not regularly exercise before becoming pregnant should begin with physical activity of very low intensity and higher levels of activity very gradually.

·  Stop your activity and consult your doctor if any unusual symptoms appear, such as the following:

-Pain

-Bleeding

-Dizziness

-Shortness of breath

-Palpitations (irregular heartbeat)

-Faintness

-Tachycardia (rapid heartbeat)

-Back pain

-Pubic pain

-Difficulty walking

Almost any form of exercise is safe if it is done in moderation. Some exercises offer aerobic conditioning of the heart and lungs; others relieve stress and tone muscles. Pregnancy causes many changes in your body, some of which have an effect on your ability to exercise. These changes can interfere with activities that require good balance, so you may wish to modify your form of exercise during pregnancy.

1. Walking is always good exercise. If you were not active before you become pregnant, walking is a good way to begin an exercise program.

2. Swimming can be continued if you were used to swimming before pregnancy. Swimming is excellent for your body because it uses many different muscles while the water supports your weight. However, it is best not to dive in the later months of pregnancy. Scuba diving is not recommended during pregnancy.

3. Jogging can be done in moderation if you were used to jogging before you become pregnant. Avoid becoming overheated, stop if you are feeling uncomfortable or unusually tired, and drink water to replace what you lose through sweating. 

4.Tennis is generally safe if you were used to playing tennis before pregnancy, but be aware of your change in balance and how it affects rapid movements.

5. Golf and bowling are fine for recreation bit don’t really strengthen the heart and lungs. With either of these sports, you may have to adjust to your change of balance.

6. Snow skiing, water skiing, and surfing pose some risk. You can hit the ground or water with great force, and taking a fall at such fast speeds could harm you or your fetus. Before you decide to participate, you should talk with your doctor.

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Pregnancy Related Disability for Employees

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Childbirth Preparation

Pain or discomfort is a natural part of childbirth for most women. Most pregnant women are concerned about how they will cope with labour and childbirth. It is difficult to know in advance how much pain or discomfort you will have during birth or how you will deal with it. You may find it helpful to learn how pain can be relieved with childbirth preparation techniques or drugs, or a combination of both.

Parents to be often attend childbirth preparation classes to learn relaxation techniques for labour and delivery.

Childbirth preparation is a means of coping with pain and reducing discomfort. The most common methods of preparation-Lamaze, Bradley, and Read-are based on the theory that much of the pain of childbirth is caused by fear and tension. Although there are differences in specific techniques, classes usually seek to relieve pain through the general principles of education, support, relaxation, paced, breathing, focusing, and touch.

If you want further information about a particular method of childbirth preparation, ask your doctor to refer you to a childbirth educator. And our next post about it ............
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Pregnancy Related Disability for Employees

Having a disability means that you are not able to work because of physical problems that could interfere with your ability to perform your usual duties. Only you and your doctor can decide whether your pregnancy is partially or totally disabling. A disability may fall into any of three categories:

1. Disability of the pregnancy itself. Some women suffer side effects such as nausea, vomiting, indigestion problems, dizziness, and swollen legs and ankles during pregnancy. Your doctor should re-evaluate these minor problems at regular intervals.

2. Disability related to complications. More serious complications, such as infection, bleeding, or early rupture of the amniotic sac, may cause disability. Also, medical conditions you had before becoming pregnant, such as heart disease, diabetes, or high blood pressure, may be disabling during pregnancy.

3. Disability related to job exposure. Some disabilities may be job related linked with such factors as exposure to high levels of toxic substances.

If your doctor decides that your pregnancy is disabling, you may request a letter to verify to your employer that you are eligible for disability benefits. Likewise, if your doctor says you are able to keep working.

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